White structureless areas are a dermatoscopic feature of invasive cutaneous squamous cell carcinoma (cSCC) that is associated with antihypertensive therapy use, but the firm clinical implications of this association are not yet fully understood, according to study findings published in Dermatologic Therapy.

In this study, a small team of researchers from Turkey examined the dermatoscopic features of 64 keratinizing skin cancer lesions in 46 patients (mean age, 69.8±13.2 years). The researchers also collected the number, duration, and localization of these lesions. In total, 29 patients had actinic keratosis (AK), 5 patients had intraepidermal carcinoma (IEC), 10 patients had cSCC, and 2 patients had keratoacanthoma.

After the features were evaluated according to histopathologic diagnosis, patients were then classified into 2 groups based on whether they took an antihypertensive therapy (n=22) or did not use a blood pressure lowering mediation (n=24).


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Approximately 30.4% of patients and 37% of patients had skin type 2 and 3, respectively. Most patients did not wear sunglasses or use sunscreen.

Patients with cSCC lesions more often showed evidence of keratin and linear-irregular vessels (P <.001). There was a significant association between IEC and scale (P =.04) and glomerular vessels (P <.001). In addition, there was a statistically significant association between keratoacanthoma and central keratin, hairpin, and branched vessels (P <.001). Keratoacanthoma, IEC, and cSCC featured significantly more ulceration, blood spot, and white structureless area than AK (P <.001).

There was no significant difference between patients who used versus those who did not use antihypertensives in regard to the lesions’ dermatoscopic features. In regard to histopathologic diagnosis, a total of 5 CSS lesions had white structureless area, with 4 found in patients who used antihypertensive therapies. White structureless area in cSCC lesions was significantly associated with antihypertensive use (P =.004).

Limitations of this study included the small sample size as well as the lack of granularity on the specific antihypertensive drug classes prescribed and their relation to dermatoscopic features of the lesions.

The researchers concluded that their main “finding in cSCC may be a clue for antihypertensive drug usage and these drugs may be a predisposition factor for dermal fibrosis.”

Reference

Demirdag HG, Tugrul B. Evaluation of relationship between antihypertensive drug usage and dermatoscopic features in patients with keratinizing skin cancer. Dermatol Ther.  Published online April 11, 2021. doi:10.1111/dth.14957